BLDG (0104-339)LICENSED CONTRACTOR DECLARATION
� affirm under penalty ofperjury that | am nmmxed under provisions of
;Qnap�r8 (commencing with Go�ion7OOo>of Division Business and
Professionals Code, and myLicense ioinfull force an Re t�`
�uvemo# uu.c�a ' Exp. Date
l - Ak
` c^
n�~ Sin ' mm
~~-�r--�~-- _- �-----
6-0(
OVVNER'BU|LoERoECLARATuON
I hereby affirm under penalty nfperjury that |omexempt from the Commmuro.
License Law for the following reason:
(l | as owner of the pmparty, employees with their sole
compensation, will do the work, and the structure is not inten'ded or offered for
sale (Sec. 7044, Business & Professionals Code).
as o . wner of the property, am exclusively contracting with licensed
contractors t6 construct the project (Sec. 7044, Business & Professionals
(I r)" I am exempt under Section B&P.C. for this reason
~
WORKERS COMPENS4TMDECLARuT|ON
~
l^homby affirm under penalty of perjury one of the following declarations:
')| have and.wiUmaintain ucertificate o(consent mself-insure for workers'
oomponnetion, as provided for by Section o7uoo/the Labor Code, for the
performance ofthe work for which this permit ioissued.
have and will maintain workers' compensation insurance, oorequired by
Gndtion 3700 of the Labor Code, for the performance of the work for which this
permit is. issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
^8TATrs P%ND 137(00040
(This section need not beed �t��m �����x$10��m��
( ) |oo�i�that inthe pononnan000ftho'wmrkfor which this permit ioissued,
| shall not employ any person inany manner aoaatobecome subject mthe
wm,ke r- compensation laws of California,and,agree that if | should b000mo.'
spbj9dt to the workers' compensation provisign's of Section 37000 of the Labor
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
a ' dclition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application »/hemuymade mthe Director m,Buimmgand Safety
^jr a pennh' ovb0oy to the conditions and mo,ionono om forth on his
�
application.
�1.Each person upon whose u6haxthis application iomade ueach person ax
whose request and for whose benefit work ioperformed under orpursuant m
any permit issued aoaresult o/this appnoeuunagrees to, ushall, indemnify
'&-hold harmless the City of LaOvinta. its officers, agents and employees.
u. Any permit issued as a result nfthis application becomes null and void if
work is not commenced within 180 days from date -of issuance of such
permit, orcessation ovwork for 1oodays will subject permit mcancellation.
^ |'oertify that | have read -this application and state that the above information is
| agree to complywith allCity, andOoatlaws relatingto the building
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
04 W4111AX
JOB SITE
APN,
ADDRESS
1.120 AVE, WAVAM0
OWNER
CONTRACTOR DESIGNER ENGINEER
,W,ZINTA, tA, 92253
-LA QTANTA CA 92.25-1
CP60)5&t�,1962 MIX 6255.
USE OF PERMIT
RUMATM) COAPT OF CONSMUMTON
00NSTRUCTION PEE 10) -IN10-41 8-000
NAPR 3 0 2001
0
CITY OF LA QUINTA
FINANCE DEPT
IMU PIUI-PAD R&M
$0100
RECEIPT
DATE-
BY
DATE FINALED
INSPECTOR
1-1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
_
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS -SPAS.'
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: